Role of liver function test parameters in acute appendicitis and its complication: a prospective study

Braja Mohan Mishra, Malaya Krishna Nayak, Sandeep Mishra, Priyambad Sahu, Dibyajyoti Das


Background: Although acute appendicitis is the most common surgically correctable cause of abdominal pain, the diagnosis is challenging. There may not be classical symptoms and signs of appendicitis always. Accurate diagnosis can be aided by biochemical testings and radiological evaluation and expectant management. These might delay laparotomy and lead to complications of appendicitis and increase the morbidity. Recent research literatures have shown that hyperbilirubinemia is a diagnostic tool for gangrenous/perforation of appendix. This study is designed to evaluate the association between the derangement of liver function test and severity of acute appendicitis and it’s complications like gangrene and perforation of appendix.

Methods: This was an observational prospective study on 66 consecutive cases of acute appendicitis done in the department of general surgery, VIMSAR, Burla. After taking informed consent, all patients included in the study were subjected to abdominal ultrasound and blood sample taken for routine blood examination, LFT and after appendicectomy histopathology examination report were collected. A master chat prepared from above data and stastical analysis done.

Results: The LFT parameters are deranged in pathological appendix and more specifically the total bilirubin level but the sensitivity, specificity and PPV are specifically high for gangrenous and perforated appendix.

Conclusions: LFT can be added as adjunctive test to the investigation of acute appendicitis and its complications and earlier diagnosis of the complications of acute appendicitis and timelier management. It can also help in prevention of negative appendicectomies.


Acute appendicitis, Gangrenous appendicitis, LFT, Perforated appendicitis

Full Text:



Fasen Geoffrey, Bruce S, Traci LH. Appendix. In:Yeo CJ, eds. Shackelford’s Surgery of the Elementary Tract. Elsevier. 8th ed. 2018:1951-1964.

Streck Jr CJ, Maxwell IV PJ. A brief history of appendicitis: familiar names and interesting patients. Am Surg. 2014;80(2):105-8.

Peranteau WH, Smink DS. Appendix, Meckel’s and other small bowel diverticula. In: Michael J. Zinner, Stanley W. Ashley, eds. Maingot’s Abdominal Operation. 12th ed. NY: McGraw-Hill; 2013:623-640.

Chaudhary P, Kumar A, Saxena N, Biswal UC. Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study. Ann Gastroenterol: Quarterly Pub Hellenic Soc Gastroenterol. 2013;26(4):325-31.

Cheekuri SK, Mohanty A, Ganesh T, Kannan R, Smile R. Hyperbilirubinemia as a predictor of the severity of acute appendicitis-an observational study. Int Surg J. 2017;4(4):1341-4.

Vaziri M, Pazouki A, Tamannaie Z, Maghsoudloo F, Pishgahroudsari M, Chaichian S. Comparison of pre-operative bilirubin level in simple appendicitis and perforated appendicitis. Med J Islam Rep Iran. 2013;27(3):109-12.

Utili R, Abernathy CO, Zimmerman HJ. Cholestatic effects of Escherichia coli endotoxin, endotoxin on the isolated perfused rat liver. Gastroenterol. 1976;70(2):248-53.

Utili R, Abernathy CO, Zimmerman HJ. Studies on the effects of E. coli endotoxin on canalicular bile formation in the isolated perfused rat liver. J Lab Clin Med. 1977; 89(3):471-82.

Dieulafoy G. The appendiceal liver: abscesses of faith concise with appendicitis. Semin Med (Paris). 1898;18:449.

Sisson RG, Ahlvin RC, Harlow MC. Superficial mucosal ulceration and the pathogenesis of acute appendicitis. Am J Surg. 1971 Sep 1;122(3):378-80.

Estrada JJ, Petrosyan M, Barnhart J, Tao M, Sohn H, Towfigh S, Mason RJ. Hyperbilirubinemia in appendicitis: a new predictor of perforation. J Gastrointest Surg. 2007;11(6):714-8.

Yadav S, Chandra K.Liver function test as a marker for acute appendicitis. Janaki Med Coll J Med Sci. 2015;3(1):31-6.

Vineed S, Naik RH. Diagnostic accuracy of hyperbilirubinemia in predicting perforated appendicitis. Int Surg J. 2017;4(10):3441-4.

Khan S. Evaluation of hyperbilirubinemia in acute inflammation of appendix: a prospective study of 45 cases. Kathmandu Uni Med J. 2006;4(3):281-9.

Kabir SA, Kabir SI, Sun R, Jafferbhoy S, Karim A. How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence. Int J Surg. 2017;40:155-62.

Jamaluddin M, Hussain SM, Ahmad H. Hyperbilirubinaemia a predictive factor for complicated acute appendicitis: a study in a tertiary care hospital. J Pak Med Assoc. 2013;63:1374-8.

Franson TR, Hierholzer Jr WJ, LaBrecque DR. Frequency and characteristics of hyperbilirubinemia associated with bacteremia. Rev Infectious Dis. 1985;7(1):1-9.

Alanis-Rivera B, Zuñiga-Vazquez LA, Silva-Escamilla MD. Hyperbilirubinemia as a predictive factor of perforated appendicitis. Med J Mexican Inst Social Security. 2016; 54 (5): 552-61.

Sand M, Bechara FG, Holland-Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg. 2009;198(2):193-8.

Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults. A prospective study. Ann Surg. 1995;221(3):278.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.

Jurić I, Primorac D, Žagar Ž, Biocǐć M, Pavić S, Furlan D, et al. Frequency of portal and systemic bacteremia in acute appendicitis. Pediatr Int. 2001;43(2):152-6.

Wang PI, Chaudry IH. Mechanism of hepatocellular dysfunction during hyperdynamic sepsis. Am J Physiol-Regulatory, Integrative and Comparative Physiol. 1996;270(5):R927-38.